We’ve all seen the Cymbalta media blitz. ”Depression Hurts.” It will probably echo for years like, “I’ve fallen and I can’t get up.” I’m glad to see acknowledgement of what I have known most of my adult life from my own experience, the mind and the body are not separate entities. What affects the psyche affects the physical body and vise versa. There is a much broader recognition of the physical effects of depression these days. There are also more helpful medical treatments for depression. I think this makes it easier for doctors to acknowledge it as a real problem and not a character flaw, having specific treatment to recommend.
It is unfortunate, but there is a lag in the recognition of anxiety as a serious, treatable problem with widespread physical effects. In my opinion this stems from the lack of reliable, effective treatments that take no more effort than writing on a scrip pad. Anxiety is a much tougher nut to crack than depression and it places a significant economic burden on society in terms of lost productivity and comorbid conditions. See this abstract on PubMed for some specific numbers. Here’s another citation from Science Daily about the hidden effects of anxiety on academic performance. I found an excellent discussion of generalized anxiety disorder on the Mayo Clinic website if you’d like more information. Generalized anxiety disorder tends to be a chronic remitting-relapsing problem which rarely completely resolves. Medications and psychotherapy can help tremendously, but treatment may go on for many years or lifelong and at great expense.
In the mean time, anxiety takes its toll on the body. Anxiety has been associated with higher morbidity and mortality from conditions such as heart disease, more dental problems, GI problems, headaches. According to this study published in the journal Medical Health, anxiety “contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work.”
One phenomenon I find puzzling is the practice some doctors have of labeling symptoms of unknown origin, “anxiety,” often with a bit of derision. It’s as if the symptoms become unimportant if they are anxiety related and don’t warrant treatment, no matter how distressing they are to the patient. There are two disturbing problems here. One is the willingness of medical providers to dismiss physical symptoms because of their inability to determine cause. The other is the implication that the symptom is unimportant if it is caused by anxiety. This leaves the patient in the untenable position of suffering a distressing symptom and being told that they will not be treated. I am not saying all medical providers subscribe to this philosophy, however I have heard many stories from people who have experienced this treatment. Sometimes with dire health consequences, usually with dire emotional consequences.
So what can be done for this dreadful, chronic anxiety? There are several medications that have been found to be helpful. Not magic cures, just helpful. Psychotherapy is also helpful. The combination of the two even more so. The Mayo Clinic article covers these in brief. As far as psychotherapy goes, cognitive behavior therapy is the most often mentioned but is far from the only type of psychotherapy available. The disproportionate attention to CBT is most likely due to it being a limited time therapy that is easily standardized and has strong research backing for effectiveness in the treatment of various disorders. This doesn’t detract from the helpfulness of longer term supportive therapy in many cases.
What I hope people can take away from this discussion is a recognition of the role anxiety plays in both exacerbation of existing physical symptoms and causing physical symptoms. I hope in the future people won’t have to hide their anxiety problems from health care providers for fear of getting labeled and left untreated.